Skip to main content
Log in

Simultaneous integrated boost intensity-modulated radiotherapy in esophageal carcinoma

Early results of a phase II study

Intensitätsmodulierte Radiotherapie mit simultan integriertem Boost beim Ösophaguskarzinom Frühe

Ergebnisse einer Phase-II-Studie

Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Purpose

The safety and efficacy of using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for patients with esophageal squamous cell carcinoma were evaluated in a single-institution phase II setting.

Methods and materials

Between June 2007 and October 2009, 45 patients underwent concurrent chemoradiotherapy (n = 27) or radiotherapy alone (n = 18). Two planning target volumes (PTV) were defined for the SIB: PTVC and PTVG, with prescribed doses of 50.4 Gy to the PTVC (1.8 Gy/fraction) and 63 Gy to the PTVG (2.25 Gy/fraction), both given in 28 fractions.

Results

At a median follow-up interval of 20.3 months, the 3-year overall survival (OS) and progression-free survival (PFS) rates were 42.2 and 40.7 %, respectively. The median overall survival time was 21 months; locoregional control rates were 83.3 % at 1 year and 67.5 % at 3 years. According to CTCAE (version 3.0) criteria, none of the patients developed grade 4–5 toxicity. The most common grade 2 and 3 radiation-related toxicity was radiation esophagitis, occurring in 64 % of all patients (but only 13 % as grade 3). No patient developed grade > 2 pulmonary complications.

Conclusion

SIB-IMRT is a feasible therapeutic approach for esophageal carcinoma patients and provides encouraging locoregional control with a low toxicity profile. Further investigations should focus on dose escalation and optimization of the combination with systemic therapies.

Zusammenfassung

Ziel

Die Wirksamkeit und Effektivität einer intensitätsmodulierten Radiotherapie mit einem simultan integrierten Boost (SIB-IMRT) für Patienten mit Ösophaguskarzinom wurde in einer Single-Institution-Phase-II-Studie bewertet.

Methoden und Material

Zwischen Juni 2007 und Oktober 2009 wurden 45 Patienten mit einer simultanen Radiochemotherapie (n = 27) oder einer alleinigen Strahlentherapie (n = 18) behandelt. Zwei Planungszielvolumen (PTV) wurden für die SIB definiert: PTVC und PTVG, mit vorgeschriebenen Dosen von 50,4 Gy für PTVC (1,8 Gy/Fraktion) und 63 Gy für PTVG (2,25 Gy/Fraktion), beide in 28 Fraktionen verabreicht.

Ergebnisse

Bei einer mittleren Verlaufsbeobachtung von 20,3 Monaten lagen die 3-Jahres-Überlebensraten für das Gesamtüberleben (OS) und das progressionsfreie Überleben (PFS) bei jeweils 42,2 und 40,7 %. Das mediane OS betrug 21 Monate; lokoregionäre Kontrollraten waren 83,3 % nach 1 Jahr und 67,5 % nach 3 Jahren. Bei keinem Patienten entwickelten sich eine Toxizität von Grad 4–5 gemäß der CTCAE-Kriterien (Version 3.0). Die häufigste strahlenbedingte Toxizität von Grad 2 und 3 war bei 64 % aller Patienten eine Ösophagitis (aber nur 13 % mit Grad 3). Bei keinem Patienten entwickelten sich pulmonale Komplikationen > Grad 2.

Schlussfolgerung

SIB-IMRT funktioniert grundsätzlich für Patienten mit Ösophaguskarzinom. Es bewirkt eine Förderung der lokoregionären Kontrolle mit akzeptabler Toxizität. Weitere Untersuchungen zur Dosissteigerung und Optimierung der Kombination sollten mit einer systemischen Therapie durchgeführt werden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Cooper JS, Guo MD, Herskovic A et al (1999) Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). JAMA 281:1623–1627

    Article  CAS  PubMed  Google Scholar 

  2. Minsky BD, Pajak TF, Ginsberg RJ et al (2002) INT 0123 (radiation therapy oncology group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20:1167–1174

    Article  CAS  PubMed  Google Scholar 

  3. National Comprehensive Cancer Network guidelines for Esophageal Cancer, Version v.2 (2012) http://www.nccn.org/professionals/physician_gls/PDF/esophageal.pdf

  4. Welsh J, Settle SH, Amini A et al (2012) Failure patterns in patients with esophageal cancer treated with definitive chemoradiation. Cancer 118:2632–2640

    Article  PubMed Central  PubMed  Google Scholar 

  5. Shukovsky LJ, Fletcher GH (1973) Time-dose and tumor volume relationships in the irradiation of squamous cell carcinoma of the tonsillar fossa. Radiology 107:621–626

    Article  CAS  PubMed  Google Scholar 

  6. Zhao KL, Shi XH, Jiang GL et al (2004) Late-course accelerated hyperfractionated radiotherapy for localized esophageal carcinoma. Int J Radiat Oncol Biol Phys 60:123–129

    Article  PubMed  Google Scholar 

  7. Wang Y, Shi XH, He SQ et al (2002) Comparison between continuous accelerated hyperfractionated and late-course accelerated hyperfractionated radiotherapy for esophageal carcinoma. Int J Radiat Oncol Biol Phys 54:131–136

    Article  PubMed  Google Scholar 

  8. Zhao KL, Shi XH, Jiang GL et al (2005) Late course accelerated hyperfractionated radiotherapy plus concurrent chemotherapy for squamous cell carcinoma of the esophagus: a phase III randomized study. Int J Radiat Oncol Biol Phys 62:1014–1020

    Article  CAS  PubMed  Google Scholar 

  9. Alongi F, Fogliata A, Navarria P et al (2012) Moderate hypofractionation and simultaneous integrated boost with volumetric modulated arc therapy (RapidArc) for prostate cancer. Strahlenther Onkol 188:990–996

    Article  CAS  PubMed  Google Scholar 

  10. Peponi E, Glanzmann C, Kunz G et al (2010) Simultaneous integrated boost intensity-modulated radiotherapy in nasopharyngeal cancer. Strahlenther Onkol 186:135–142

    Article  PubMed  Google Scholar 

  11. Kim K, Wu HG, Kim HJ et al (2009) Intensity-modulated radiation therapy with simultaneous integrated boost technique following neoadjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma. Head Neck-J Sci Spec 31:1121–1128

    Article  Google Scholar 

  12. Vandecasteele K, De Neve W, De Gersem W et al (2009) Intensity-modulated arc therapy with simultaneous integrated boost in the treatment of primary irresectable cervical cancer. Strahlenther Onkol 185:799–907

    Article  PubMed  Google Scholar 

  13. Nguyen GH, Murph MM, Chang JY (2011) Cancer stem cell radioresistance and enrichment: where frontline radiation therapy may fail in lung and esophageal cancers. Cancers 3:1232–1252

    Article  PubMed Central  PubMed  Google Scholar 

  14. Fu WH, Wang LH, Zhou ZM et al (2004) Comparison of conformal and intensity-modulated techniques for simultaneous integrated boost radiotherapy of upper esophageal carcinoma. World J Gastroenterol 10:1098–1102

    PubMed  Google Scholar 

  15. Welsh J, Palmer MB, Ajani JA et al (2012) Esophageal cancer dose escalation using a simultaneous integrated boost technique. Int J Radiat Oncol Biol Phys 82:468–474

    Article  PubMed Central  PubMed  Google Scholar 

  16. Japan ES (2008) Japanese classification of esophageal cancer, 10th ed. Tokyo, Kanehara

  17. Moss AA, Schnyder P, Thoeni RF et al (1981) Esophageal carcinoma pre-therapy staging by computed tomography. Am J Roentgenol 136:1051–1056

    Article  CAS  Google Scholar 

  18. Gu YJ, Wang JH, Xiang JQ et al (2002) A study on clinical value of CT features of tracheoesophageal groove lymph node metastasis of thoracic esophageal carcinoma. Chin J Radiol 36:139–141

    Google Scholar 

  19. Zhao KL, Ma JB, Liu G et al (2010) Three-dimensional conformal radiation therapy for esophageal squamous cell carcinoma: is elective nodal irradiation necessary? Int J Radiat Oncol Biol Phys 76:446–451

    Article  PubMed  Google Scholar 

  20. Nitin O, Maria WW, Inga SG et al (2012) Modeling local control after hypofractionated stereotactic body radiation therapy for stage I non-small cell lung cancer: a report from the Elekta Collaborative Lung Research group. Int J Radiat Oncol Biol Phys 84:E379–E384

    Google Scholar 

  21. Liu M, Shi X, Guo X et al (2012) Long-term outcome of irradiation with or without chemotherapy for esophageal squamous cell carcinoma: a final report on a prospective trial. Radiat Oncol 7:142

    Article  PubMed Central  PubMed  Google Scholar 

  22. Jatoi A, Foster NR, Egner JR et al (2010) Older versus younger patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction, and stomach: a pooled analysis of eight consecutive North Central Cancer Treatment Group (NCCTG) trials. Int J Oncol 36:601–606

    Article  CAS  PubMed  Google Scholar 

  23. Mak RH, Mamon HJ, Ryan DP et al (2010) Toxicity and outcomes after chemoradiation for esophageal cancer in patients age 75 or older. Dis Esophagus 23:316–323

    Article  CAS  PubMed  Google Scholar 

  24. Vallböhmer D, Hölscher AH, Brabender J et al (2008) Clinicopathologic and prognostic factors of young and elderly patients with esophageal adenocarcinoma: is there really a difference? Dis Esophagus 21:596–600

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Xiao-Long Fu M.D..

Additional information

Wei-Wei Yu and Zheng-Fei Zhu contributed equally to this work, and both should be considered first author.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yu, WW., Zhu, ZF., Fu, XL. et al. Simultaneous integrated boost intensity-modulated radiotherapy in esophageal carcinoma. Strahlenther Onkol 190, 979–986 (2014). https://doi.org/10.1007/s00066-014-0636-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-014-0636-y

Keywords

Schlüsselwörter

Navigation